Senate opens health care debate with success in doubt

With the Senate set to begin debate today on a health care overhaul, the all-hands-on-deck Democratic coalition that allowed the bill to advance is fracturing already. Yet majority Democrats will need 60 votes again to finish.

Some Democratic senators say they'll jump ship from the bill without tighter restrictions on abortion coverage. Others say they'll go unless a government plan to compete with private insurance companies gets tossed overboard. Such concessions would enrage liberals, the heart and soul of the party.

There's no clear course for Senate Majority Leader Harry Reid, D-Nev., to steer legislation through Congress to President Barack Obama. History can't be made unless 60 votes are reached, and he can't count on Republicans to help.

But Reid is determined to avoid being remembered as another Democrat who tried and failed to make health care access for the middle class a part of America's social safety net.

"Generation after generation has called on us to fix this broken system," he said at a recent Capitol Hill rally. "We're now closer than ever to getting it done."

Reid's bill includes $848 billion over 10 years to gradually expand coverage to most of those now uninsured. It would ban onerous insurance industry practices such as denying coverage or charging higher premiums because of someone's poor health. Those who now have the hardest time getting coverage — the self-employed and small businesses — could buy a policy in a new insurance market, with government subsidies for many. Older people would get better prescription coverage.

Most covered by big employers would gain more protections without major changes. An exception would be those with high-cost insurance plans, whose premiums could rise as a result of a tax on insurers who issue the coverage.

The Senate debate, however, risks alienating the public because much of the discussion probably will revolve around divisive issues that preoccupy lawmakers. "A large portion of the debate will be spent on issues that aren't important to the workability of health reform," said Paul Ginsburg, president of the Center for Studying Health System Change.

The debate should start off modestly, with each side offering one amendment. No votes are scheduled today.

But with more than 40 senators on the two committees that originated the bill, many more amendments are expected. Some likely subjects are limits on malpractice lawsuits, consumer choice, affordability, minority health and drug prices.

Reid wants to finish by Christmas. He's hoping that Democrats will stick together on procedural matters, where Senate rules require 60 votes to advance. That would allow for different views to be heard on the underlying questions. But such an accommodation might not always be possible.

For example, the National Right to Life to Committee says unless there are big changes, it will count the procedural motion to allow a final up-or-down vote on the legislation as tantamount to a vote on abortion.

Of the many issues senators have to weigh, abortion funding and the option of a government insurance plan promise to be the most difficult.

The public is ambivalent about the Democrats' legislation. While 58 percent want elected officials to tackle health care now, about half of those supporters say they don't like what they're hearing about the plans, according to a new Kaiser Family Foundation poll.

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Poll results mixed

The public is ambivalent about the Democrats' legislation. While 58 percent want elected officials to tackle health care now, about half of those supporters say they don't like what they're hearing about the plans, according to a new Kaiser Family Foundation poll.